{"reporting_entity_name": "Imagine360", "reporting_entity_type": "Third party administrator", "last_updated_on": "2026-07-27", "version": "2.1.0", "out_of_network": [{"name": "IADNA SARSCOV2 & INF A&B & RSV MULT AMP PROBE TQ", "billing_code_type": "CPT", "billing_code_type_version": "2.1.0", "billing_code": "87637", "description": "IADNA SARSCOV2 & INF A&B & RSV MULT AMP PROBE TQ", "allowed_amounts": [{"tin": {"type": "ein", "value": "39-3905164"}, "service_code": ["81"], "billing_class": "professional", "payments": [{"allowed_amount": 0, "providers": [{"billed_charge": 300, "npi": [0]}]}]}]}, {"name": "IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ", "billing_code_type": "CPT", "billing_code_type_version": "2.1.0", "billing_code": "87636", "description": "IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ", "allowed_amounts": [{"tin": {"type": "ein", "value": "39-3905164"}, "service_code": ["81"], "billing_class": "professional", "payments": [{"allowed_amount": 12.23, "providers": [{"billed_charge": 234, "npi": [0]}]}]}, {"tin": {"type": "ein", "value": "39-4856209"}, "service_code": ["81"], "billing_class": "professional", "payments": [{"allowed_amount": 0, "providers": [{"billed_charge": 234, "npi": [0]}]}]}]}, {"name": "SUPPLIES&MATERIALS ABOVE/BEYOND PROV BY PHYS/QHP", "billing_code_type": "CPT", "billing_code_type_version": "2.1.0", "billing_code": "99070", "description": "SUPPLIES&MATERIALS ABOVE/BEYOND PROV BY PHYS/QHP", "allowed_amounts": [{"tin": {"type": "ein", "value": "27-1535521"}, "service_code": ["99"], "billing_class": "professional", "payments": [{"allowed_amount": 15.34, "providers": [{"billed_charge": 15.34, "npi": [0]}]}]}]}]}